Villa San Juan Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPAs), Armando Perez and Robert Campbell made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs were granted entry by staff to conduct the inspection and met with administrator, Teodora San Juan. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of three (3) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, a kitchen, dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 134.0 degrees F, the proper warning sign was posted. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. LPA reviewed three (3) client records. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. Continued on LIC 809-C. LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights and training verification. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the hallway allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher will need to be serviced after 12/31/2026. Emergency drills are conducted quarterly at the facility with the last drill on 11/5/2025 . Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative, and a copy was provided.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Prelicensing

On 11/26/24 at 1:38 PM Licensing Program Analyst (LPA) Ferrer Sabarias and Licensing Program Manager (LPM) Tricia Danielson made an announced visit to the facility to conduct a pre-licensing inspection. LPA and LPM met with Applicant Teodora San Juan who accompanied LPA and LPM throughout today's inspection. The applicant has applied for a Change of Ownership (CHOW), Residential Care for the Elderly (RCFE), aged 60 and above. The facility has an approved hospice waiver for (3) of which (2) are currently receiving services. On 07/11/24 The Hemet Fire Department approved the facility for (5) non ambulatory residents and (1) bedridden resident. The facility is a one story structure. There are three bedrooms for residents and one bedroom for staff, there are three bathrooms, dining room, living room and the kitchen. There is an attached garage, backyard with a covered patio, and plenty of space to walk and participate in outdoor activities. The facility was observed to have the required postings, and operable smoke and carbon monoxide detectors, and (1) fully charged fire extinguishers last serviced date 7/11/24. The facility was observed to have a sufficient food supply of 2 day of perishable and a 7-day supply of nonperishable food items. Continue to LIC809-C Continue from LIC809 The facility is equipped with nonskid mats, grab bars and shower chairs. The resident bedrooms were observed to have adequate lighting, clean linen, chest of drawers, and chairs. The hot water temperature was checked and measured at 115.8 degrees Fahrenheit which is within regulatory limits. The medications are being stored inside a locked cabinet inside the hallway inside the kitchen, as well as the staff and resident files. There are no pools or bodies of water or known guns or ammunition on the premises. Completion of COMP III orientation is still pending, and facility was observed to possess valid liability insurance. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22 Chapter 6, Division 8. Based on the observations and evaluation of the facility on this date, Pre-Licensing is complete, and this facility has no deficiencies. An exit interview was conducted, and a copy of this report was provided to Teodora San Juan, Applicant.the state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Sep 2, 2024